Excisional Biopsy for Eyelid Lesions

Excisional biopsy is a procedure to completely remove a growth or lesion from the eyelid for both treatment and microscopic examination. This approach ensures accurate diagnosis while often providing definitive treatment in a single procedure.

Why Biopsy Is Important

Many types of lumps and bumps can develop on the eyelids. While most are benign (non-cancerous), some may be precancerous or malignant. Because the eyelids receive significant sun exposure and have unique tissue characteristics, several types of skin cancer can occur in this area.

Common benign lesions include:

• Papillomas (skin tags)

• Seborrhoeic keratoses

• Cysts

• Moles (naevi)

Lesions requiring careful evaluation include:

• Basal cell carcinoma (the most common eyelid cancer)

• Squamous cell carcinoma

• Sebaceous cell carcinoma

• Melanoma (rare)

The American Academy of Ophthalmology emphasises the importance of proper evaluation of eyelid lesions.

When Excision Is Recommended

Your ophthalmologist may recommend excisional biopsy when:

• A lesion has features suspicious for malignancy

• A growth is changing in size, shape, or colour

• There is loss of eyelashes in the area

• The lesion bleeds easily or does not heal

• A persistent lesion causes symptoms (irritation, discomfort)

• Definitive diagnosis is needed

• The lesion is cosmetically bothersome

Warning signs that warrant prompt evaluation:

• Pearly, shiny, or waxy appearance

• Irregular borders

• Ulceration that does not heal

• Loss of normal eyelid architecture

• Recurrent "chalazion" in the same location

The Procedure

Excisional biopsy is typically performed as an office procedure:

• Local anaesthetic numbs the eyelid

• The lesion is removed completely with a margin of normal tissue

• The wound is closed with fine sutures placed in natural skin creases

• The specimen is sent for pathological examination

• The procedure takes 20-45 minutes depending on size and location

For suspected malignancies, wider margins may be taken. Complex cases may require specialised techniques or reconstruction.

What Results Can Be Expected

Diagnostic accuracy: Pathological examination provides definitive diagnosis.

Treatment outcomes:

• Most benign lesions are cured with complete excision

• For malignant lesions, outcomes depend on the type and whether margins are clear

• Basal cell carcinoma has excellent cure rates when completely removed

• Further treatment may be needed if margins are involved or for aggressive tumour types

Results of the pathology examination are typically available within 1-2 weeks.

Potential Risks

• Bruising and swelling are expected and resolve over 1-2 weeks

• Scarring is usually minimal when incisions follow natural creases

• Infection is uncommon with proper wound care

• Incomplete excision may require additional surgery

• Eyelid notching or asymmetry is possible depending on lesion size

• Temporary difficulty closing the eye may occur with larger excisions

• Recurrence is possible, particularly for some types of malignancy

After receiving results: Your doctor will discuss the findings and whether any additional treatment or monitoring is needed.

Medical Disclaimer: This information provides general guidance about excisional biopsy for eyelid lesions and should not replace professional medical advice. Any new or changing eyelid lesion should be evaluated by an eye care professional. Outcomes depend on the nature of the lesion and individual factors. If malignancy is confirmed, additional treatment and surveillance may be required. Please consult with our ophthalmologists for proper evaluation of any concerning eyelid growth.